tag:blogger.com,1999:blog-26666124.post3113857388479138905..comments2015-03-03T11:57:53.323-05:00Comments on Shrink Rap: Here's When You Need A PsychiatristDinahnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-26666124.post-70472129327643087182014-01-07T10:33:18.150-05:002014-01-07T10:33:18.150-05:00This is an old thread which I found via a search f...This is an old thread which I found via a search for &quot;lithium&quot;, but when I was in college (93-97), my PCP at University Health Services didn&#39;t prescribe an antidepressant. A psychiatrist did at UHS, and it was the social worker who referred me after I pushed hard to explain how poorly I was functioning and that talking to her wasn&#39;t enough. SSRIs were new then, and the zoloft I was given came with a prescription for desipramine to counteract any potentially activation from the zoloft. Do PCPs like to prescribe tricyclics? I don&#39;t think that mine wanted anything to do with being the prescriber.<br /><br />I would add another category to the list of people who should be seen by a psychiatrist: anyone who has a family history of serious mental illness (at the very least psychosis, depression that required hospitalization or ECT) or substance abuse. At least for an initial evaluation.EastCoasternoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-84472347310667655352011-09-29T03:25:27.524-04:002011-09-29T03:25:27.524-04:00wow. i&#39;m kind of appalled. for a lot of those ...wow. i&#39;m kind of appalled. for a lot of those issues a psychiatrist isn&#39;t definitely necessary, medication shouldn&#39;t be the first course of action for anxiety or depression. psychotherapy can just as well help. we&#39;re all way too medicated... although it does feel pretty great.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39417709297635448352010-09-22T12:33:47.703-04:002010-09-22T12:33:47.703-04:00my brother has been stable on Lithium for the past...my brother has been stable on Lithium for the past 8.5 years. and yes, the psychiatrist said he doesn&#39;t need her to prescribe it.Anxiety Disordershttp://ceritatalita.blogspot.com/noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-20147203147582296372008-01-26T01:20:00.000-05:002008-01-26T01:20:00.000-05:00Excellent post and comments.I'm with Dr Smak--the ...Excellent post and comments.<BR/><BR/>I'm with Dr Smak--the number of patients in my primary care practice whom I'd like to get to a mental health professional of ANY kind vastly outnumbers that number who eventually go. We have exactly one psychiatrist in town who takes Medicare, the rest require payment up front. We have a list of mental health professionals that I give to most patients with depression, anxiety, or simply life stresses (marital, job, family problems).janemariemdhttp://www.blogger.com/profile/04456131748909653894noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-12053933008700573302008-01-24T02:37:00.000-05:002008-01-24T02:37:00.000-05:00Someone beat me to the eating disorder suggestion....Someone beat me to the eating disorder suggestion. And that needs to be a team approach, not just psychiatry. Psychiastrist, therapist and nutritionist. <BR/><BR/>Question about your anti xanax for anxiety ..what about when it's the only drug the insurance covers for anxiety and anxiety is a severe issue?Dreaming againhttp://www.blogger.com/profile/15717590226520457326noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-66530819492125653442008-01-22T22:03:00.000-05:002008-01-22T22:03:00.000-05:00Oops, that was psych, not psycho.Freudian slip, an...Oops, that was psych, not psycho.<BR/><BR/>Freudian slip, anyone?Dr. Smakhttp://www.blogger.com/profile/11578423336319528698noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-82763368060665989042008-01-22T22:02:00.000-05:002008-01-22T22:02:00.000-05:00Great post, Dinah - I personally will go through t...Great post, Dinah - <BR/><BR/>I personally will go through two SSRI trials before I recommend psychiatry to patients (whom I otherwise think are primary care appropriate.) <BR/><BR/>In all honesty, my biggest struggle is getting patients who are not primary care appropriate to see psych. They don't want to drive. Their insurance doesn't pay well for it. They don't want to have to go to another appointment. Can't you just refill it while I see you for my diabetes, hyperlipidemia, hypertension, and did I mention my left elbow hurts?<BR/><BR/>How some primary care doctors do counseling is beyond me. In my visits, I barely get through SIGECAPS.<BR/><BR/>Conservatively, I'd say at least half of my patients whom I treat for mental health should probably be seeing a psycho and getting counseling/therapy. I'm not holding my breath. <BR/><BR/>Thanks for your take on who should be referred.Dr. Smakhttp://www.blogger.com/profile/11578423336319528698noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-8079013593510920472008-01-22T20:39:00.000-05:002008-01-22T20:39:00.000-05:00Sorrel, partly to show the breadth of what we can ...Sorrel, partly to show the breadth of what we can do, if I just think of official psychiatric diagnoses (and exclude things like "stress" and "bereavements" and the like that aren't in ICD-10) a lot's still left that Dinah's thinking Primary Care docs can initially have a stab at :<BR/>- alcohol misuse<BR/>- substance misuse<BR/>- a past psychotic episode that's now in remission<BR/>- mild mood disorder (that although is called 'mild' as a specific psychiatric diagnostic term <A HREF="http://www.who.int/classifications/apps/icd/icd10online/" REL="nofollow">ICD-10 </A>F32.0, the psychological impact can be intense)<BR/>- chronic low grade mood states such as dysthmia<BR/>- phobic disorders<BR/>- panic disorders<BR/>- generalised anxiety disorders<BR/>- obsessive-compulsive disorders<BR/>- dissociative/conversion disorders<BR/>- depersonalisation/derealisation<BR/>- neurasthenia (mental and physical fatigue)<BR/>- acute stress reactions<BR/>- somatisation disorders<BR/>- sleep disorders<BR/>- sexual dysfunction<BR/>- postnatal depression<BR/>- personality disorders<BR/>- habit and impulse disorders<BR/>- gender identity issues<BR/>- mental retardation<BR/>- disorders of speech and language development<BR/>- specific developmental disorders of scholastic skills, pervasive developmental disorders, childhood autism<BR/>- hyperkinetic disorders (e.g. ADHD)<BR/>- childhood conduct disordersThe Shrinkhttp://www.blogger.com/profile/10009039342346247138noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-41327196796376495442008-01-22T20:25:00.000-05:002008-01-22T20:25:00.000-05:00That's interesting, aqua, considering I kind of ha...That's interesting, aqua, considering I kind of had an opposite experience ... I got forced (um, I mean, encouraged very strongly) to see a psychiatrist and I didn't want to. (But now am VERY glad I did.)sorrelsorrel55.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-6109588926760093192008-01-22T20:20:00.000-05:002008-01-22T20:20:00.000-05:00Completely agree that psychosis and BPD should see...Completely agree that psychosis and BPD should see us.<BR/><BR/>I'd also add, simply 'cause we haev the expertise to enhance their care :<BR/>- eating disorders<BR/>- dementia<BR/>- incapacitated adults (i.e. those who lack capacity to make decisions) with neuropsychiatric sequelae to their disorder, where Primary Care doctors are making management decisions acting in their best interests<BR/><BR/><I>distress due to psychiatric illness is such that they can't contain it <B>and</B> are driving the primary care doc nuts</I><BR/>I'd swap the "and" for "or" there.<BR/>If the patient is quite content with grappling in Primary Care but the Primary Care doctor is feeling at their wits end, I'm keen to see their patients. I may not be able to effect change in the patient's management plan but I <I><B>can</I></B> generate a credible management plan for the Primary Care doctor.<BR/>Helping support our Primary Care colleagues is a useful role that's valued.The Shrinkhttp://www.blogger.com/profile/10009039342346247138noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-4924994281186812582008-01-22T15:43:00.000-05:002008-01-22T15:43:00.000-05:00This is interesting, because last week on my blog ...This is interesting, because last week on my blog I wrote my story about how it took 18 years for me to be referred to a psychiatrist. Timely post. <BR/><BR/>I hope referrals are done better now than they were when I was struggling for so long to get the help I need.Aquahttp://www.blogger.com/profile/16230285017033299419noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-69520161454254800512008-01-22T13:21:00.000-05:002008-01-22T13:21:00.000-05:00Let's see ... the shrink gets anyone with serious ...Let's see ... the shrink gets anyone with serious suicidal ideation (their life is at risk), psychotic symptoms, bipolar disorder, failure of one antidepressant, or anything significantly screwing up their life. Well ... what's left? Really mild dysthymia or really mild anxiety? I question whether that kind of thing should even be treated with medication at all.sorrelsorrel55.wordpress.comnoreply@blogger.com